Over a decade ago, my father was diagnosed with
chronic lymphocytic leukemia. Since then, I've been very open about his
disease when talking with friends, colleagues...really with anyone who
asked or was interested.

Yet, he suffers from another illness I've been silent
about: depression.

Sadly, it's not out of concern for his privacy.
Rather, it's because of the strong stigma associated with it.
Leukemia...tragic, poor guy, can't the doctors do anything?
Depression...why doesn't he just snap out of it?

Unfortunately, my father is not alone. Today, members
of three generations of my family are on prescription antidepressants to
deal with this difficult and deeply personal illness.

I'm not talking about "the blues" or having
a particularly stressful day. I'm talking about people who are uncertain
about how they will get out of bed that morning, crying for days after
spilling ice cream on the counter, not opening their mail for weeks at a
time because they simply can't face the sheer volume of it.

So as a member of this family, I admit that I've been
very grateful for antidepressants because they have let the people I
love get out of bed every morning and face the day.

Yet, as the director of HSI, I've tried to work with
them and their doctors to find suitable natural alternatives that are
effective enough to give the results they need but without the long list
of side effects associated with the drugs. And the list continues to
grow. Now we are discovering a new side effect, the risks which increase
with age.

A new study published in the British Medical Journal
shows that the use of antidepressants can increase the risk of upper
gastrointestinal bleeding for people over 65. And the newer types of
antidepressants - the ones now prescribed most often - are the worst
offenders.

All antidepressants work by manipulating the brain's
use of serotonin, the chemical largely responsible for your mood. Under
ideal conditions, the brain cells secrete serotonin in response to
signals from other parts of the brain. The serotonin then travels across
synapses and bonds with serotonin receptors on other cells. After all
the receptors are full, the original cell reabsorbs any unused
serotonin, a process known in medical terms as "reuptake."
Antidepressants work by interfering with the reuptake process, allowing
more serotonin to circulate freely in the brain. More circulating
serotonin makes you feel calm, peaceful, and content.

But the newest and most popular class of
antidepressants, called selective serotonin reuptake inhibitors (SSRIs),
blocks even more serotonin from being reabsorbed. And while this has
been praised as a breakthrough in the treatment of depression, it also
robs the platelets of serotonin, which they need for clotting. Usually,
platelets use the excess serotonin absorbed during reuptake. But when
that supply is blocked by SSRIs, the platelets have less serotonin to
work with - and consequently, the blood is thinner.

Thinner blood may be a good thing for some people;
many take prescription drugs or aspirin each day for just that benefit.
But this may be a case of too much of a good thing. According to the BMJ
study, doctors have reported many years' worth of anecdotal evidence
associating SSRIs with a "variety of bleeding events." But
until now, there hadn't been much well-designed, in-depth research into
this dangerous side effect.

In the new study, researchers tracked 317,824 people
over 65 in Ontario, Canada, from 1992 to 1998.

Participants took a variety of antidepressants. The
researchers classified them according to the strength of their
inhibition effect. For example, SSRIs like paroxetine (Paxil),
sertraline (Zoloft), and fluoxetine (Prozac) were in the high group.
Older tricyclic antidepressants like imipramine (Impril, Tofranil) and
amitriptyline (Elavil, Levate) were classified as intermediate, while
desipramine (Norpramin) and doxepin (Sinequan) were classified as low.

In short, here's what they found: the higher the
inhibition of serotonin, the greater the risk of upper gastrointestinal
bleeding. During the study period, 974 participants had upper GI
bleeding incidents. Of those, 41 percent occurred in people taking drugs
in the high group. The risk of gastrointestinal bleeding jumped more
than nine percent between the low and intermediate groups, and another
nine percent between the intermediate and the high group.

They also found that certain groups are at even
greater risk from these drugs. For instance, people in their 80s had
nearly three times the risk of a upper GI bleed as people between 65 and
70. People with prior gastrointestinal bleeding had nearly five times
the risk as people who had never had the problem. And a variety of drugs
were found to compound the effects; for example, use of glucocorticoids
or anticoagulants doubled the risk, while use of NSAIDs increased the
risk nearly three times.

This may be the most recently studied side effect of
SSRIs, but it is hardly the only one. SSRIs can also cause nausea,
headache, anxiety, dry mouth, insomnia, sexual dysfunction, diarrhea,
and tremors. The worst possible side effect is serotonin syndrome, a
frightening condition characterized by psychotic episodes. Side effects
from Paxil (a popular SSRI in the high group) can be so extreme that
users have filed a lawsuit against its manufacturer. The suit claims
that users endured horrific side effects like electric-like shocks and
suicidal thoughts when they stopped taking the drug.

If you are over 65 and you take an SSRI
antidepressant, talk to your doctor about your risk of upper GI
bleeding. This study tells us that you are at particular risk if you are
80 or older, have had previous episodes of bleeding, or have diabetes.
Taking SSRIs in conjunction with some drugs may also increase your risk;
talk to your doctor if you regularly take NSAIDs, aspirin,
glucocorticoids, anticoagulants, or peptic ulcer treatment.

And remember, as I mentioned above, prescription
antidepressants are NOT the only option for dealing with depression. Some
people have found relief simply by addressing underlying nutrient
deficiencies.

Studies have found that many people respond just as
well to these natural therapies as they do to prescription
antidepressants, without the toxic side effects. However, there are
still concerns about drug interactions, particularly with St. John's
Wort. Take stock of all medications you take and discuss the change with
your doctor before switching. And NEVER take St. John's Wort while
taking SSRIs - that can also lead to serotonin syndrome.

If you've been taking antidepressants and have been
helped by them, the idea of discontinuing them can be daunting in
itself. Make sure you discuss any treatment decisions and concerns not
only with your physician but with your therapist, as well.